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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (5 May 2020) | Viewed by 41255

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Prof. Dr. Li-Tung Huang

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Guest Editor

Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung 83301, Taiwan
Interests: child health; programming; cognition; neuroscience; nitric oxide; obesity; metabolic syndrome; melatonin
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Special Issue Information

Dear Colleagues,

IJERPH is planning a Special Issue focusing on Maternal and Early-life Nutrition and Health. Nutritional challenges, including caloric restriction, macronutrient excess, and micronutrient insufficiencies during early development, i.e. prior to and during gestation, lactation, and early-life, are known to influence lifelong health. Therefore, disturbances of quality and quantity of nutrition during these sensitive time periods of development can increase the risk to develop common adult disorders, such as obesity, metabolic syndrome, cardiovascular disorder, nonalcoholic fatty liver disease, cognitive function, as well as neuropsychological disorders. Nutritional programming has become a hot research topic.

This Special Issue aims to bring together the latest research on the role of nutrition, both prior to and during pregnancy, and in early-life, on placenta function, fetal growth, and offspring development. Studies on a broad range of topics, including maternal dietary intake, neonatal and early-life nutrition, placenta pathology, and future child and adult health are warranted. Original preclinical and clinical studies, meta-analyses, and review articles will be considered. This issue seeks to provide a comprehensive composite of the advances in perinatal nutrition that can impact health.

Prof. Li-Tung Huang
Guest Editor

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Keywords

Maternal nutrition
Early-life nutrition
Nutritional programming
Maternal obesity
Placenta
Intrauterine growth retardation
Fetus

Published Papers (14 papers)

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Editorial

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Open AccessEditorial

Maternal and Early-Life Nutrition and Health

Li-Tung Huang

Int. J. Environ. Res. Public Health 2020, 17(21), 7982; https://doi.org/10.3390/ijerph17217982 - 30 Oct 2020

Cited by 8 | Viewed by 3252

Abstract

Nutritional challenges prior to and during gestation, lactation, and early life are known to influence the lifelong health of the infant. In this editorial, I briefly discuss the 13 articles published in this Special Issue, “Maternal and Early-Life Nutrition and Health”. This Special Issue discusses topics including maternal nutrition behaviors, maternal overnutrition/obesity, maternal iron deficiency, breastfeeding, and others. This issue paves the way to better understand perinatal nutrition and how it can impact maternal and offspring health. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

Research

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Open AccessArticle

Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort

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Int. J. Environ. Res. Public Health 2020, 17(21), 7851; https://doi.org/10.3390/ijerph17217851 - 27 Oct 2020

Cited by 6 | Viewed by 1609

Abstract

Excessive Postpartum Weight Retention (PWR) is postulated to increase the risk of adverse health outcomes for mothers and offspring. Using data from the Mother and Infant Nutritional Assessment (MINA) cohort in Lebanon and Qatar, this study aimed to examine PWR and its determinants at 6 months after delivery. Pregnant women (n = 183) were recruited during their first trimester and were followed up through pregnancy and after delivery. During this period, face-to-face interviews as well as extraction from medical charts were conducted to collect data regarding the socioeconomic, anthropometric and dietary intake of participants. The mean PWR (kg) among participants was 3.1 ± 5.6 at delivery, and 3.3 ± 5.3 and 2.7 ± 4.7 at 4 and 6 months after delivery, respectively. Results of the multiple logistic regression analyses showed that a Qatari nationality and excessive GWG were associated with higher odds of a high PWR (above median) while an insufficient GWG had lower odds. After adjustment for energy, participants with a high PWR reported a greater intake of proteins, Trans fat, cholesterol, sodium and lower intakes of mono and polyunsaturated fat as compared to those with a low PWR (below median). These findings suggested priority areas for interventions to prevent excessive PWR amongst women of childbearing age in Lebanon and Qatar. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

Maternal Iron Deficiency Programs Offspring Cognition and Its Relationship with Gastrointestinal Microbiota and Metabolites

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Int. J. Environ. Res. Public Health 2020, 17(17), 6070; https://doi.org/10.3390/ijerph17176070 - 20 Aug 2020

Cited by 6 | Viewed by 2944

Abstract

Iron is an essential micronutrient for the brain development of the fetus. Altered intestinal microbiota might affect behavior and cognition through the so-called microbiota-gut-brain axis. We used a Sprague-Dawley rat model of a maternal low-iron diet to explore the changes in cognition, dorsal hippocampal brain-derived neurotrophic factor (BDNF) and related pathways, gut microbiota, and related metabolites in adult male offspring. We established maternal iron-deficient rats by feeding them a low-iron diet (2.9 mg/kg), while the control rats were fed a standard diet (52.3 mg/kg). We used a Morris water maze test to assess spatial learning and long-term memory. Western blot (WB) assays and a quantitative reverse-transcription polymerase chain reaction (qRT-PCR) were used to detect the BDNF concentration and related signaling pathways. We collected fecal samples for microbiota profiling and measured the concentrations of plasma short-chain fatty acids. The adult male offspring of maternal rats fed low-iron diets before pregnancy, during pregnancy and throughout the lactation period had (1) spatial deficits, (2) a decreased BDNF mRNA expression and protein concentrations, accompanied by a decreased TrkB protein abundance, (3) a decreased plasma acetate concentration, and (4) an enrichment of the Bacteroidaceae genus Bacteroides and Lachnospiraceae genus Marvinbryantia. Maternal iron deficiency leads to an offspring spatial deficit and is associated with alternations in gastrointestinal microbiota and metabolites. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

The UK Pregnancies Better Eating and Activity Trial (UPBEAT); Pregnancy Outcomes and Health Behaviours by Obesity Class

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Int. J. Environ. Res. Public Health 2020, 17(13), 4712; https://doi.org/10.3390/ijerph17134712 - 30 Jun 2020

Cited by 4 | Viewed by 1859

Abstract

The effectiveness of antenatal intervention in women with increasing obesity is unknown. This study investigated whether there was a differential effect of antenatal intervention on diet, physical activity and pregnancy outcomes in women stratified by obesity class using data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) (n = 1555). The stratification was by World Health Organization classifications: Class I, II and III (30–34.9 kg/m², 35–39.9 kg/m² and ≥40 kg/m²). Using linear and logistic regression, adjusted for confounders, outcomes were assessed post-intervention (27⁺⁰–28⁺⁶ weeks’ gestation) and in late pregnancy (34⁺⁰–36⁺⁰ weeks’ gestation). Interactions between obesity class and the intervention were explored. Compared to the standard care arm, class III intervention women had lower gestational weight gain (GWG) (−1.87 kg; 95% CI −3.29 to −0.47, p = 0.009), and the effect of the intervention was greater in class III compared to class I, by −2.01 kg (95% CI −3.45 to −0.57, p = 0.006). Class I and II intervention women reported significantly lower dietary glycaemic load and saturated fat intake across their pregnancy. This differential effect of the intervention suggests antenatal interventions for women with obesity should stratify outcomes by obesity severity. This would inform evidence-based antenatal strategies for high-risk groups, including women with a BMI ≥ 40 kg/m². Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

Environmental Stimulation Counteracts the Suppressive Effects of Maternal High-Fructose Diet on Cell Proliferation and Neuronal Differentiation in the Dentate Gyrus of Adult Female Offspring via Histone Deacetylase 4

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Int. J. Environ. Res. Public Health 2020, 17(11), 3919; https://doi.org/10.3390/ijerph17113919 - 01 Jun 2020

Cited by 8 | Viewed by 1910

Abstract

Maternal high-fructose diets (HFD) impair the learning and memory capacity of adult female offspring via histone deacetylase 4 (HDAC4). Hippocampal adult neurogenesis is important for supporting the function of existing neural circuits. In this study, we investigated the effects of maternal HFD on hippocampal neural stem cell (NSC) proliferation and neuronal differentiation in adult offspring. Increased nuclear HDAC4 enzyme activity was detected in the hippocampus of HFD female offspring. The Western blot analyses indicated that the expressions of sex-determining region Y box2 (SOX2) and the transcription factor Paired Box 6 (PAX6), which are critical for the progression of NSC proliferation and differentiation, were downregulated. Concurrently, the expression of Ki67 (a cellular marker for proliferation) and doublecortin (DCX), which are related to NSC division and neuronal differentiation, was suppressed. Intracerebroventricular infusion with class II HDAC inhibitor (Mc1568, 4 weeks) led to the upregulation of these proteins. Environmental stimulation reversed the expression of Ki67 and DCX and the counts of Ki67- and DCX-positive cells in the hippocampi of HFD offspring as a result of providing the enriched housing for 4 weeks. Together, these results demonstrate that the suppressive effects of maternal HFD on hippocampal NSC proliferation and neuronal differentiation are reversibly mediated through HDAC4 and can be effectively reversed by environmental stimulation. The advantageous effects of environmental enrichment were possibly mediated by HDAC4 suppression. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

Maternal Resveratrol Treatment Re-Programs and Maternal High-Fat Diet-Induced Retroperitoneal Adiposity in Male Offspring

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Int. J. Environ. Res. Public Health 2020, 17(8), 2780; https://doi.org/10.3390/ijerph17082780 - 17 Apr 2020

Cited by 13 | Viewed by 1993

Abstract

Obesity during pregnancy increases the risk of cardiovascular problems, diabetes, asthma, and cognitive impairments, affecting the offspring. It is important to reduce the negative effects of obesity and high-fat (HF) diet during pregnancy. We employed a rat model of maternal HF diet to evaluate the possible de-programming effects of resveratrol in rodent male offspring with maternal HF diet/obesity. Male rat offspring were randomized into four groups: maternal control diet/postnatal control diet, maternal HF diet/postnatal control diet, maternal control diet plus maternal resveratrol treatment/postnatal control diet, and maternal HF diet plus maternal resveratrol treatment/postnatal control diet. Maternal HF diet during pregnancy plus lactation resulted in retroperitoneal adiposity in the male offspring. Maternal resveratrol treatment re-programmed maternal HF exposure-induced visceral adiposity. Offspring that received prenatal HF diet showed higher leptin/soluble leptin receptor (sOB-R) ratio than offspring that received prenatal control diet. Maternal resveratrol treatment ameliorated maternal HF exposure-induced increase in leptin/sOB-R ratio and altered the expression of genes for crucial fatty acid synthesis enzymes in the offspring. Thus, maternal resveratrol administration reduces retroperitoneal adiposity in rat offspring exposed to prenatal HF diet/obesity and could be used to ameliorate negative effects of maternal HF diet in the offspring. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

Factors Associated with Preterm Birth and Low Birth Weight in Abu Dhabi, the United Arab Emirates

Zainab Taha

Ahmed Ali Hassan

Ludmilla Wikkeling-Scott

and

Dimitrios Papandreou

Int. J. Environ. Res. Public Health 2020, 17(4), 1382; https://doi.org/10.3390/ijerph17041382 - 21 Feb 2020

Cited by 25 | Viewed by 3129

Abstract

Both preterm birth and low birth weight (LBW) represent major public health problems worldwide due to their association with the catastrophic effects of morbidity and mortality. Few data exist about such adverse pregnancy outcomes. The current study aimed to investigate the prevalence of and factors associated with preterm birth and LBW among mothers of children under two years in Abu Dhabi, United Arab Emirates. Data were collected in clinical and non-clinical settings across various geographical areas in Abu Dhabi. The data were analyzed using both descriptive and inferential statistics. A total of 1610 mother–child pairs were included in the current study. Preterm birth rate was 102 (6.3%) with a 95% confidence interval [CI] (6.1%, 6.5%) and the LBW rate was 151 (9.4%) with a 95% CI (9.3%, 9.5%). The mean (SD) of gestational age (GA) and birth weight at delivery was 39.1 (1.9) weeks and 3080.3 (518.6) grams, respectively. Factors that were positively associated with preterm birth were Arab mothers, maternal education level below secondary, caesarean section, and LBW. LBW was associated with female children, caesarean section (CS), first child order, and preterm birth. The current study highlighted the need for further interventional research to tackle these public health issues such as reducing the high CS rate and improving maternal education. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

Open AccessArticle

Dietary Folate Intake and Folic Acid Supplements among Pregnant Women from Southern Italy: Evidence from the “Mamma & Bambino” Cohort

Martina Barchitta

Andrea Maugeri

Roberta Magnano San Lio

and

Int. J. Environ. Res. Public Health 2020, 17(2), 638; https://doi.org/10.3390/ijerph17020638 - 19 Jan 2020

Cited by 18 | Viewed by 3074

Abstract

Folate requirement among women who plan to become pregnant should be raised to 600 μg/day during the periconceptional period. To meet this need, several countries began to promote the use of folic acid supplements before and during pregnancy. Here, we investigated prevalence and determinants of dietary folate intake and folic acid supplement use among 397 pregnant women (aged 15–50 years old, median = 37 years old). We also investigated their effects on neonatal outcomes in a subgroup of women who completed pregnancy. For doing that, we used data from the “Mamma & Bambino” project, an ongoing mother-child cohort settled in Catania (Italy). Inadequate folate intake was evaluated using a Food Frequency Questionnaire and defined as an intake < 600 μg/day. Women were also classified as non-users (i.e., women who did not use folic acid supplements), insufficient users (i.e., women who did not take folic acid supplements as recommended), and recommended users of folic acid supplements. Neonatal outcomes of interest were preterm birth (PTB) and small for gestational age (SGA). Nearly 65% of women (n = 257) reported inadequate folate intake, while 74.8% and 22.4% were respectively classified as insufficient or recommended users of supplements. We demonstrated higher odds of inadequate folate intake among smoking women (OR = 1.457; 95%CI = 1.046–2.030; p = 0.026), those who followed dietary restrictions (OR = 2.180; 95%CI = 1.085–4.378; p = 0.029), and those with low adherence to the Mediterranean Diet (OR = 3.194; 95%CI = 1.958–5.210; p < 0.001). In a subsample of 282 women who completed pregnancy, we also noted a higher percentage of SGA among those with inadequate folate intake (p < 0.001). Among 257 women with inadequate folate intake, those with low educational level were more likely to not take folic acid supplements than their more educated counterpart (OR = 5.574; 95%CI = 1.487–21.435; p = 0.012). In a subsample of 184 women with inadequate folate intake and complete pregnancy, we observed a higher proportion of SGA newborns among women who did not take supplement before pregnancy and those who did not take at all (p = 0.009). We also noted that the proportion of PTB was higher among non-users and insufficient users of folic acid supplements, but difference was not statistically significant. Our study underlined the need for improving the adherence of pregnant women with recommendations for dietary folate intake and supplement use. Although we proposed a protective effect of folic acid supplement use on risk of SGA, further research is encouraged to corroborate our findings and to investigate other factors involved. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

Mothers’ Expectations and Factors Influencing Exclusive Breastfeeding during the First 6 Months

Esmeralda Santacruz-Salas

Isaac Aranda-Reneo

Antonio Segura-Fragoso

Ana Isabel Cobo-Cuenca

José Alberto Laredo-Aguilera

and

Juan Manuel Carmona-Torres

Int. J. Environ. Res. Public Health 2020, 17(1), 77; https://doi.org/10.3390/ijerph17010077 - 20 Dec 2019

Cited by 16 | Viewed by 3506

Abstract

The aims were to determine Spanish women’s expectations about exclusive breastfeeding (EB) and the effect of expectations and other factors on EB during the first 6 months. A prospective cohort study was conducted with 236 participants. Variables were maternal age, marital status, occupation, expectations about breastfeeding, knowledge about breastfeeding, type of delivery, type of feeding, and duration of EB. Data were collected through three personal interviews, at the hospital (before delivery) and in two telephone calls in the first and sixth months postpartum. Average age was 32.3 years (SD = 5.3); average duration of EB was 2.73 months (SD = 2.49). Of 236 women who had decided to breastfeed before birth, 201 (85.2%) offered EB after delivery. Achievement of expectations was most influenced by the decision to continue breastfeeding ‘as long as I can’ (OR: 5.4; CI: 2.0–14.6) and previous experience (OR: 3.2; CI: 1.2–8.5). Knowledge of breastfeeding acquired from relatives (OR: 9.2; CI: 3.0–27.9), caesarean delivery (OR: 4.6; CI: 1.7–12.8) and maternal age (36–40 years old) (OR: 7.5; CI: 1.8–30.9) were associated with failure to achieve EB. Achievement of EB may depend on a woman’s confidence in her ability to do so and on knowledge obtained in the social environment. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

The Nutritional Behaviour of Pregnant Women in Poland

Katarzyna Ługowska

and

Wojciech Kolanowski

Int. J. Environ. Res. Public Health 2019, 16(22), 4357; https://doi.org/10.3390/ijerph16224357 - 08 Nov 2019

Cited by 10 | Viewed by 3958

Abstract

A woman’s diet during pregnancy can significantly affect her health, as well as her child’s future development and well-being. Unfortunately, many pregnant women do not follow the recommended nutritional guidelines. The reason could be that they have insufficient knowledge about nutritional best practice. Accordingly, the purpose of this study is to investigate the nutritional behaviour of pregnant women in Poland. The research was conducted using a questionnaire to survey a sample of N = 815 pregnant women in first pregnancy. Among the findings were that the subjects ate an excessive amount of sweets, and white bread, and consumed insufficient quantities of fish, milk and fermented milk drinks. Subjects chose white bread more often than wholemeal bread, and fruit rather than vegetables. The study showed that the nutritional behaviour of pregnant women was characterised by many bad practices. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessArticle

Determinants of Continued Breastfeeding at 12 and 24 Months: Results of an Australian Cohort Study

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Int. J. Environ. Res. Public Health 2019, 16(20), 3980; https://doi.org/10.3390/ijerph16203980 - 18 Oct 2019

Cited by 20 | Viewed by 3121

Abstract

Breastfeeding to 12 months and beyond offers considerable health benefits to both infants and mothers. Despite these recognized benefits, relatively few women in high income countries breastfeed for 12 months, and rarely breastfeed to 24 months. The aim of this study was to identify the prevalence and determinants of continued breastfeeding to 12 and 24 months amongst a cohort of Australian women participating in the Adelaide-based Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE). Duration of breastfeeding was known for 1450 participants and was derived from feeding related data collected at birth, 3, 6, 12 and 24 months. Multivariable logistic regression analysis was used to investigate the relationship between explanatory variables and continued breastfeeding to 12 and 24 months. In total, 31.8% of women breastfed to 12 months and 7.5% to 24 months. Women who were multiparous, university educated, had not returned to work by 12 months and whose partners preferred breastfeeding over bottle feeding were more likely to be breastfeeding at 12 months. While women who had introduced complementary foods before 17 weeks and formula at any age were less likely to be breastfeeding at 12 months. Mothers who were born in Asian countries other than India and China, had not returned to work by 12 months and had not introduced formula were more likely to be breastfeeding at 24 months. The majority of the determinants of continued breastfeeding are either modifiable or could be used to identify women who would benefit from additional breastfeeding support and encouragement. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

Review

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Open AccessReview

Maternal Obesity Programs Offspring Development and Resveratrol Potentially Reprograms the Effects of Maternal Obesity

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Int. J. Environ. Res. Public Health 2020, 17(5), 1610; https://doi.org/10.3390/ijerph17051610 - 02 Mar 2020

Cited by 14 | Viewed by 2754

Abstract

Maternal obesity during pregnancy is a now a public health burden that may be the culprit underlying the ever-increasing rates of adult obesity worldwide. Understanding the association between maternal obesity and adult offspring’s obesity would inform policy and practice regarding offspring health through available resources and interventions. This review first summarizes the programming effects of maternal obesity and discusses the possible underlying mechanisms. We then summarize the current evidence suggesting that maternal consumption of resveratrol is helpful in maternal obesity and alleviates its consequences. In conclusion, maternal obesity can program offspring development in an adverse way. Maternal resveratrol could be considered as a potential regimen in reprogramming adverse outcomes in the context of maternal obesity. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessReview

Breastfeeding and the Risk of Infant Illness in Asia: A Review

Mi Kyung Lee

and

Colin Binns

Int. J. Environ. Res. Public Health 2020, 17(1), 186; https://doi.org/10.3390/ijerph17010186 - 26 Dec 2019

Cited by 25 | Viewed by 5317

Abstract

Infancy remains the most vulnerable period of human life for death, illness, and establishing a lifetime trajectory of growth and health. It is estimated that there are 5.3 million deaths under five years of age worldwide and approximately 800,000 lives could be saved by improving breastfeeding rates and duration. In Asia, an estimated 300,000–350,000 child deaths could be prevented with optimal breastfeeding and the majority would be under 12 months of age. We present a systematic review of studies of infection and breastfeeding in infants in Asia and further review interactions of selected infectious diseases and breastfeeding. Initially, 2459 records of possible interest were identified, 153 full text papers were reviewed in detail, and 13 papers describing diarrhoeal disease and/or acute respiratory tract infection were selected for inclusion in the review. Additional papers were selected to discuss specific diseases and their relationship to breastfeeding. The review found that a variety of methods were used with differing definitions of breastfeeding and diseases. Overall, breastfeeding when compared to the use of infant formula, is associated with significantly lower rates of diarrhoeal disease and lower respiratory tract infection, with a reduction of 50% or more to be expected, especially in infants under six months of age. The relationship between breastfeeding and specific diseases including measles and HTLV1 were reviewed. Breastfeeding reduces some disease rates, but there remain a few conditions where breastfeeding may be contra-indicated. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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Open AccessCase Report

A False-Positive Case of Methylmalonic Aciduria by Tandem Mass Spectrometry Newborn Screening Dependent on Maternal Malnutrition in Pregnancy

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Int. J. Environ. Res. Public Health 2020, 17(10), 3601; https://doi.org/10.3390/ijerph17103601 - 20 May 2020

Cited by 12 | Viewed by 2255

Abstract

Methylmalonic Acidurias (MMAs) are a group of inborn errors of metabolism (IEMs), specifically of propionate catabolism characterized by gastrointestinal and neurometabolic manifestations resulting from a deficiency in the function of methylmalonyl-CoA mutase, methylmalonyl-CoA epimerase, and cobalamin metabolism. In Expanded Newborn Screening (NBS), increased levels of propionylcarnitine (C3) and/or of its ratios by MS/MS analysis of dried blood spots (DBS) samples are suggestive for either Propionic Acidemia or MMAs. C3 elevation is not considered a specific marker for these disorders, resulting in high false-positive rates. The use of analyte ratios improves specificity, but it still cannot resolve the diagnostic issue. Second-tier testing are strongly recommended as confirmation of primary NBS results and for a differential diagnosis. LC-MS/MS analysis allows the quantification of more specific markers of the disorder. Here, we report the case of a newborn with a suspected MMA at Expanded NBS and at second-tier test. Given the urgent situation, in-depth diagnostic investigations were performed. Further investigations surprisingly revealed a Vitamin B12 deficiency due to a maternal malnutrition during pregnancy. This case emphasized that metabolic alterations at NBS may not only be influenced by genome and related to IEMs, but also to external factors and to maternal conditions. Full article

(This article belongs to the Special Issue Maternal and Early-Life Nutrition and Health)

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